| NPI | 1871556365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WI 5086) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 5086) |
| 103G00000X Clinical Neuropsychologist (Licence: CO 2917) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2023-12-27 |